Indigenous men at higher risk of developing aggressive prostate cancer, study finds

Indigenous men have more serious later-stage prostate cancer when diagnosed than non-Indigenous men, a new Canadian study says.

“It is very clear from this data that Indigenous men are at higher risk of developing aggressive prostate cancer than non-Indigenous men,” said Dr. Adam Kinnaird, senior author of the study and the Frank and Carla Sojonky Chair in Prostate Cancer Research at the University of Alberta.

The study, published Monday in the journal Cancer, looked at prostate cancer screening data among nearly 1.5 million men in Alberta between 2014 and 2022. They were all between the ages of 50 and 70.

Using zip codes, the researchers found that men in First Nations and Métis communities were much less likely to have a prostate-specific antigen (PSA) test — the method used to screen for prostate cancer — than men who live outside Indigenous communities.

“Non-Indigenous men get their PSA tested 50 percent more often than Indigenous men. And that’s a pretty big difference,” Kinnaird said.

The lack of screening, he said, could be a contributing factor to the study’s other key finding: that at the time of diagnosis, prostate cancer in Indigenous men was more advanced and aggressive than in non-Indigenous men.

That finding was based on the tumor characteristics of 6,049 men diagnosed with prostate cancer who were seen at urologic referral centers at the University of Alberta in Edmonton and at the University of Calgary.

Dr. Jason Pennington, a surgeon with the Scarborough Health Network and Indigenous leader of Ontario’s Central East Regional Cancer Program, said the results are “not surprising.”

“[They are] actually supports findings we got out of Ontario,” said Pennington, who was not involved in the study and is a member of the Huron-Wendat Nation.

“This is what we’re seeing across Canada and among Indigenous populations around the world.”

A weakness of the study, Kinnaird said, is that because it relied on zip codes, it couldn’t compare the rate of PSA testing between Indigenous and non-Indigenous men living in cities.

About half of the Indigenous population lives in cities, he said, and researchers will look at data in another study in Alberta to find testing rates for urban Indigenous men.

Screening rates and severity

Kinnaird’s team also plans additional research to determine whether or not there is a genetic factor that could make Native men more susceptible to aggressive prostate cancer, he said.

That’s something that’s prevalent in the Ashkenazi Jewish population, he said.

The study did not look at whether prostate cancer was more or less common in Indigenous men – only at screening rates and severity at diagnosis.

There are many possible reasons why Native men are both less tested and have more advanced prostate cancer, Pennington said.

Lack of access to a primary care provider to get screened is a likely factor, he said, along with social determinants of health, such as poverty, that could make it difficult for someone to take time off from work to get a PSA test. to get.

Kinnaird said it’s critical that health care providers are aware of the disparity of prostate cancer screening.

“It’s something that’s important for Indigenous men, for general practitioners, for nurse specialists and for urologists to keep in mind that when you see an Indigenous man in your clinic, you really think about whether you should screen for prostate cancer,” he said.

Indigenous mistrust of the health care system is another possible factor behind lower screening rates, Pennington said.

“Every Indigenous person I know, every Indigenous family I know has had negative experiences in our healthcare system,” he said.

One promising solution is holding community screening days, Pennington said, where Indigenous “patient navigators” and Indigenous nursing staff are on hand to answer questions and provide a culturally safe environment. Families can come together to help them feel more comfortable, he said.

That approach also works in remote Indigenous communities with mobile screening buses, he said.

Pennington said it’s time to implement more of these types of culturally safe Indigenous strategies and measure their success.

“We’re starting to get quite a bit of evidence now regarding the lower screening, the higher stages [of cancer]the bad results,” he said.

“It’s time we did something about it.”